ARTICLE: Clinical Insights About the Role of pH in Acne

December 2019 | Volume 18 | Issue 12 | Supplement Individual Articles | 221 | Copyright © December 2019


Charles Lynde MD FRCPC

American Board of Dermatology, Royal College of Physicians and Surgeons of Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada, Lynderm Research, Markham, ON, Canada 

Jerry Tan MD FRCPC

Royal College of Physicians and Surgeons of Canada, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, Windsor, ON, Canada, Windsor Clinical Research Inc., The Healthy Image Centre, Windsor, ON, Canada Sandra Skotnicki MD FRCPC

American Board of Dermatology, the Royal College of Physicians and Surgeons of Canada, Department of Medicine, Divisions of Dermatology, and Occupational and Environmental Health, University of Toronto, Toronto, ON, Canada, Bay Dermatology Centre, Toronto, ON, Canada Anneke Andriessen PhD

Radboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands 

Jennifer Beecker MD CCFP(EM) FRCPC DABD

Royal College of Physicians and Surgeons of Canada, American Board of Dermatology, University of Ottawa, Ottawa, ON, Canada, The Ottawa Hospital, Director of Research, The Ottawa Hospital Research Institute, Ottawa, ON, Canada 

Joël Claveau MD FRCPC

American Board of Dermatology, Royal College of Physicians and Surgeons of Canada, Department of Medicine, Laval University, Quebec City, QC, Canada; Melanoma and Skin Clinic, Le Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC, Canada 

Monica K. Li MD FRCPC

Royal College of Physicians and Surgeons of Canada, Faculty of Medicine, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada, Enverus Medical, Surrey, BC, Canada and Cosmetic Dermatologist, City Medical Aesthetics Center, Vancouver, BC, Canada 

Jaggi Rao MD FRCPC

Royal College of Physicians and Surgeons of Canada, Division of Dermatology, University of Alberta, Edmonton, AB, Canada 

Jennifer Salsberg MD FRCP

Royal College of Physicians and Surgeons of Canada, University of Toronto, Women’s College Hospital, Toronto, ON, Canada, Bay Dermatology Centre, Toronto, ON, Canada Maxwell B. Sauder MD FRCPC FAAD

Royal College of Physicians and Surgeons of Canada, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, Harvard Medical School, Boston, MA, Toronto Dermatology Centre, Toronto, ON, Canada 

Catherine Zip MD FRCPC

Royal College of Physicians and Surgeons of Canada, Department of Medicine, University of Calgary, Calgary, AB, Canada, Dermatologist, Dermatology Centre, Calgary, AB, Canada

Another study showed adjuvant skin care improved adherence to topical retinoid treatment, significantly reducing acne severity.30 In a study on the use of a skin cleanser and moisturizer in patients with mild acne and dry skin, results saw a reduction in acne, an improvement in dry skin, and increased levels of endogenous ceramides in the SC.31

The panel agreed that while the number of studies on pH in acne is low, a growing body of evidence suggests the use of skin care augments skin barrier function, thereby reducing irritation and increasing adherence to treatment, thus improving outcomes.

Statement 6: Education of patients with acne on appropriate cleansing and moisturizing can improve skin barrier function, treatment adherence, and results.

Educating patients on inflammatory events and skin barrier dysfunction involved in acne lesion development is essential to understand the measures that are needed to improve skin condition.8,9 Contrary to the popular belief that drastic cleansing measures are needed to reduce sebum production and to combat inflammatory lesions, it is important to educate patients on how skin irritation and inflammation can be reduced.9,25 Once patients with acne-affected skin understand how they can manage the dryness and irritation that result from treatment and from the condition itself, they may be motivated to use cleansers and moisturizers close to physiologic skin surface pH (Figure 2).22,25

Limitations

Conclusive evidence on the role of skin pH in acne as well as on best measures to maintain an acidicphysiologic skin surface pH is lacking. Therefore, consensus statements and recommendations were based on the best available clinical evidence and reflecting the knowledge and practical experience of the expert panel.

CONCLUSIONS

Acne is associated with skin barrier dysfunction, which presents with a reduced water binding capacity due to multiple factors. Treatment can exacerbate this dysfunction, leading to dry skin and irritation, which in turn leads to poor treatment adherence and suboptimal outcomes.

More evidence on the role of skin pH in acne as well as on measures to maintain an acidic skin surface pH is needed. As an adjunct to treatment for acne, pH-balanced and ceramidecontaining cleansers and moisturizers may help in maintaining skin barrier function.

REFERENCES

 

  1. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-85. 
  2. Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-34. 
  3. Halvorsen JA, Stern RS, Dalgard F, Thoresen M, Bjertness E, Lien L. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol. 2011;131(2):363-70. 
  4. Sundström A, Alfredsson L, Sjölin-Forsberg G, Gerdén B, Bergman U, Jokinen J. Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. BMJ. 2010;341:c5812. 
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  7. Boer M, Duchnik E, Maleszka R, Marchlewicz M. Structural and biophysical characteristics of human skin in maintaining proper epidermal barrier function. Postepy Dermatol Alergol. 2016;33(1):1-5. 
  8. Thiboutot D, Del Rosso JQ. Acne vulgaris and the epidermal barrier: Is acne vulgaris associated with inherent epidermal abnormalities that cause impairment of barrier functions? Do any topical acne therapies alter the structural and/or functional integrity of the epidermal barrier? J Cosmet Dermatol. 2013;6(2):18-24. 
  9. Lovaszi M, Szegedi A, Zouboulis CC, Torocsik D. Sebaceous-immunobiology is orchestrated by sebum lipids. Dermato-endocrinology. 2017;9(1):e1375636. 
  10. Christensen GJ, Bruggemann H. Bacterial skin commensals and their role as host guardians. Benef Microbes. 2014;5(2):201-15. 
  11. Kwon HH, Suh DH. Recent progress in the research about Propionibacterium acnes strain diversity and acne: pathogen or bystander? Int J Dermatol. 2016;55(11):1196-204. 
  12. Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-8. 
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